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Patellar tendinopathy (PT) typically affects jumping‐sport athletes with functional impairments frequently observed. Alterations to the functional organization of corticomotor neurons within the motor cortex that project to working muscles are evident in some musculoskeletal conditions and linked to functional impairments. We aimed to determine if functional organization of corticomotor neuron projections differs between athletes with PT and asymptomatic controls, and if organization is associated with neuromuscular control. We used a cross‐sectional design, and the setting was Monash Biomedical Imaging. Basketball and volleyball athletes with (n = 8) and without PT (n = 8) completed knee extension and ankle dorsiflexion force matching tasks while undergoing fMRI. We determined functional organization via identification of the location of peak corticomotor neuron activation during respective tasks (expressed in X, Y, and Z coordinates) and calculated force matching accuracy for both tasks to quantify neuromuscular control. We observed significant interactions between group and coordinate plane for functional organization of corticomotor projections to knee extensors (p < 0.001) and ankle dorsiflexors (p = 0.016). Compared to controls, PT group peak corticomotor activation during the knee extension task was 9.6 mm medial (p < 0.001) and 5.2 mm posterior (p = 0.036), and during the ankle dorsiflexion task 8.2 mm inferior (p = 0.024). In the PT group, more posterior Y coordinate peak activation location during the knee extension task was associated with greater task accuracy (r = 0.749, p = 0.034). Functional organization of corticomotor neurons differed in jumping athletes with PT compared to controls. Links between functional organization and neuromuscular control in the PT group suggest organizational differences may be relevant to knee extension neuromuscular control preservation. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this systematic review is to determine the benefits and harms of heel lifts to any comparator for lower limb musculoskeletal conditions. Methods: Ovid MEDLINE, Ovid AMED, Ovid EMCARE, CINAHL Plus and SPORTDiscus were searched from inception to the end of May 2024. Randomised, quasi‐randomised or non‐randomised trials comparing heel lifts to any other intervention or no‐treatment were eligible for inclusion. Data was extracted for the outcomes of pain, disability/function, participation, participant rating of overall condition, quality of life, composite measures and adverse events. Two authors independently assessed risk of bias and certainty of evidence using the GRADE approach at the primary time point 12 weeks (or next closest). Results: Eight trials (n = 903), investigating mid‐portion Achilles tendinopathy, calcaneal apophysitis and plantar heel pain were included. Heel lifts were compared to exercise, ultrasound, cryotherapy orthotics, stretching, footwear, activity modification, felt pads and analgesic medication. No outcome was at low risk of bias and few effects (2 out of 47) were clinically important. Low‐certainty evidence (1 trial, n = 199) indicates improved pain relief (55.7 points [95% CI: 50.3–61.1], on a 100 mm visual analogue scale) with custom orthotics compared to heel lifts at 12 weeks for calcaneal apophysitis. Very low‐certainty evidence (1 trial, n = 62) indicates improved pain and function with heel lifts over indomethacin (35.5 points [95% CI: 21.1–49.9], Foot Function Index) at 12 months for plantar heel pain. Conclusions: Few trials have assessed the benefits and harms of heel lifts for lower limb musculoskeletal conditions. Only two outcomes out of 47 showed clinically meaningful between group differences. However, due to very low to low certainty evidence we are unable to be confident in the results and the true effect may be substantially different. Registration: PROSPERO registration number CRD42022309644. [ABSTRACT FROM AUTHOR]

Objective: The aim of this review was to determine how exoskeletons could assist Australian Defence Force personnel with manual handling tasks. Background: Musculoskeletal injuries due to manual handling are physically damaging to personnel and financially costly to the Australian Defence Force. Exoskeletons may minimize injury risk by supporting, augmenting, and/or amplifying the user's physical abilities. Exoskeletons are therefore of interest in determining how they could support the unique needs of military manual handling personnel. Method: Industrial and military exoskeleton studies from 1990 to 2019 were identified in the literature. This included 67 unique exoskeletons, for which Information about their current state of development was tabulated. Results: Exoskeleton support of manual handling tasks is largely through squat/deadlift (lower limb) systems (64%), with the proposed use case for these being load carrying (42%) and 78% of exoskeletons being active. Human–exoskeleton analysis was the most prevalent form of evaluation (68%) with reported reductions in back muscle activation of 15%–54%. Conclusion: The high frequency of citations of exoskeletons targeting load carrying reflects the need for devices that can support manual handling workers. Exoskeleton evaluation procedures varied across studies making comparisons difficult. The unique considerations for military applications, such as heavy external loads and load asymmetry, suggest that a significant adaptation to current technology or customized military-specific devices would be required for the introduction of exoskeletons into a military setting. Application: Exoskeletons in the literature and their potential to be adapted for application to military manual handling tasks are presented. [ABSTRACT FROM AUTHOR]

An exoskeleton is a body-worn mechanical device designed to work in concert with the user to enhance human capabilities. For the dismounted close combatant, an exoskeleton could be worn whilst performing a variety of complex tasks and duties. As such, there is a requirement for the human and the exoskeleton to readily adapt to different movements in different contexts. There have been many attempts to design an exoskeleton to improve the performance of the complex adaptive human system with limited success. Despite a vast investment in time and resources, exoskeletons have not yet been adopted for operational use by military leadership for use by the dismounted close combatant as they are yet to demonstrate substantive augmentation to individual warfighter and collective team capability. We argue that a major limitation of current exoskeleton systems is their inability to concurrently adapt to the user, task and environment. Unless a device can meet this requirement, it is unlikely to offer a comparative benefit to the dismounted close combatant. This paper will present the state of the art of current exoskeleton technology, and recommend future research necessary to reach an acceptable standard of augmentation and thereby lead to widespread adoption. [ABSTRACT FROM AUTHOR]